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Grundnig JS, Steiner-Hofbauer V, Katz H, Holzinger A. 'Good' and 'bad' doctors - a qualitative study of the Austrian public on the elements of professional medical identity. MEDICAL EDUCATION ONLINE 2022; 27:2114133. [PMID: 36004404 PMCID: PMC9423859 DOI: 10.1080/10872981.2022.2114133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Professional identity formation has become a key focus for medical education, but there is still much to learn about how to help students develop their professional identity. At a time when influential concepts such as public- and patient-centered care have become common values, there is little research on the conceptions of the public that trainees might adopt during their training. Defining characteristics of 'good' and 'bad' physicians can be a starting point when considering how to incorporate aspects of professional behavior into medical curricula. Therefore, this study examined the essential elements of physician identity from the public's perspective. This study aimed to describe the Austrian public's viewpoint about the characteristics of 'good' and 'bad' doctors. Using a qualitative research design, interviews were conducted with the Austrian public (n = 1000, mean age 46.4 ± 15.8 years). Interviews were transcribed verbatim and analyzed via qualitative content analysis. The respondents stated 2078 answers for 'good' and 1728 for 'bad' doctors. The content analysis produced seven categories: 'social skills' (36.3%), 'professional competence' (30.2%), 'personality' (10.8%), 'communication' (6.3%), 'practice organization' (5.9%), 'ethical and moral behavior' (5.7%), and 'I do not know, or I have no idea' (4.9%). The public can help medical students to construct their professional identity by supporting the exploration of and commitment to professional values that society expects of physicians. Ideally, fusing medical expertise with social skills will fulfill the ideal of what the public considers a 'good' doctor. This shared definition of a 'good physician' has several implications for medical education. Future physicians can benefit from education about the general population's medical needs as well as personal needs, fears, and concerns.
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Affiliation(s)
| | | | - Henri Katz
- Teaching Center, Medical University Vienna, Vienna, Austria
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Fabry G. Wie lassen sich professionelle Kompetenzen im Medizinstudium vermitteln? Ethik Med 2022. [DOI: 10.1007/s00481-022-00695-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shikama Y, Chiba Y, Yasuda M, Stanyon M, Otani K. The use of text mining to detect key shifts in Japanese first-year medical student professional identity formation through early exposure to non-healthcare hospital staff. BMC MEDICAL EDUCATION 2021; 21:389. [PMID: 34284770 PMCID: PMC8293517 DOI: 10.1186/s12909-021-02818-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/04/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Professional identity formation is nurtured through socialization, driven by interaction with role models, and supported through early clinical exposure (ECE) programmes. Non-healthcare professionals form part of the hospital community but are external to the culture of medicine, with their potential as role models unexplored. We employed text mining of student reflective assignments to explore the impact of socialization with non-healthcare professionals during ECE. METHODS Assignments from 259 first-year medical students at Fukushima Medical University, Japan, underwent hierarchical cluster analysis. Interrelationships between the most-frequently-occurring words were analysed to create coding rules, which were applied to elucidate underlying themes. RESULTS A shift in terms describing professional characteristics was detected, from "knowledge/skill" towards "pride [in one's work]" and "responsibility". Seven themes emerged: contribution of non-healthcare professionals, diversity of occupation, pride, responsibility, teamwork, patient care and gratitude. Students mentioning 'contribution of non-healthcare professionals' spoke of altruistic dedication and strong sense of purpose. These students expressed gratitude towards non-healthcare professionals for supporting clinical work, from a doctor's perspective. CONCLUSION Socialization with non-healthcare professionals provides important insights into the hospital working environment and cultural working norms. Through role modelling altruism and responsibility, non-healthcare professionals positively influenced student professional identity formation, promoting self-conceptualisation as a doctor.
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Affiliation(s)
- Yayoi Shikama
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Yasuko Chiba
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Megumi Yasuda
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Maham Stanyon
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koji Otani
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Brown MEL, Finn GM. When I say… socialisation. MEDICAL EDUCATION 2021; 55:780-781. [PMID: 33547816 DOI: 10.1111/medu.14469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Brown ME, Coker O, Heybourne A, Finn GM. Exploring the Hidden Curriculum's Impact on Medical Students: Professionalism, Identity Formation and the Need for Transparency. MEDICAL SCIENCE EDUCATOR 2020; 30:1107-1121. [PMID: 34457773 PMCID: PMC8368648 DOI: 10.1007/s40670-020-01021-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The hidden curriculum within medical education has been a topic of recent debate. Consensus opinion regarding the continued relevance of this term, what constitutes the hidden curriculum, and the nature of its impact do not exist. Further research is required to contribute to this debate. This work sets out to investigate which factors beyond taught cognitive knowledge influence medical students in clinical and educational environments and examine how this occurs. Semi-structured focus group interviews were conducted with 39 students from one UK medical school. Fourteen faculty were interviewed individually to triangulate data. Data were analysed using constructivist thematic analysis, informed by grounded theory convention. The presence of the hidden curriculum was clearly demonstrated, acting through role modelling, organizational culture, stereotyping and professional dress. Mentioned frequently were the influences of the hidden curriculum on student professionalism and identity development. Professionalism was perceived as being negatively impacted by the hidden curriculum and seen as an imposition from senior faculty to control students. Students believe medical identity formation begins prior to medical school, in a process known as "anticipatory socialization", a previously unstudied identity transition. Students felt covert institutional agendas negatively impacted their identity, pushing them further from the identity their institution was encouraging them to acquire. Key messages for educators include the need to explore the hidden curriculum through discussion with students. Improving transparency of organizational culture may allow students to interpret institutional agendas in the way institutions formally intend, reducing orthogonal interpretations of organizational culture and subsequent impact upon identity formation.
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Affiliation(s)
- Megan E.L. Brown
- Health Professions Education Unit, Hull York Medical School, University of York, John Hughlings Jackson Building, University Road, Heslington, York, YO10 5DD UK
| | - Oluwafemi Coker
- Health Professions Education Unit, Hull York Medical School, University of York, John Hughlings Jackson Building, University Road, Heslington, York, YO10 5DD UK
| | - Annabel Heybourne
- Health Professions Education Unit, Hull York Medical School, University of York, John Hughlings Jackson Building, University Road, Heslington, York, YO10 5DD UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, University of York, John Hughlings Jackson Building, University Road, Heslington, York, YO10 5DD UK
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Cuncic C, Regehr G, Frost H, Bates J. It's all about relationships : A qualitative study of family physicians' teaching experiences in rural longitudinal clerkships. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:100-109. [PMID: 29532346 PMCID: PMC5889386 DOI: 10.1007/s40037-018-0416-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
INTRODUCTION The relationship between preceptor and trainee is becoming recognized as a critical component of teaching, in particular in the negotiation of feedback and in the formation of professional identity. This paper elaborates on the nature of the relationships between preceptor and student that evolve in the context of rural longitudinal integrated clerkships (LICs). METHODS We drew on constructivist grounded theory for the research approach. We interviewed nine LIC family practice preceptors from three sites at one educational institution. We adapted the interview framework based on early findings. We analyzed the data through a constant comparative process. We then drew on concepts of relationship-based learning as sensitizing concepts in a secondary analysis. RESULTS We constructed three themes from the data. First, preceptors developed trusting professional and personal relationships with students over time. These relationships expanded to include friendship, advocacy, and ongoing contact beyond the clerkship year. Second, preceptors' approach to teaching was anchored in the relationship with an understanding of the individual student. Third, preceptors set learning goals collaboratively with their students, based not only on program objectives, but also with the student as a future physician in mind. DISCUSSION Our findings suggest that rural family medicine preceptors developed engaged and trusting relationships with their students over time. These relationships imbued all activities of teaching and learning with an individual and personal focus. This orientation may be a key factor in supporting the learning outcomes demonstrated for students studying in rural LICs.
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Affiliation(s)
- Cary Cuncic
- Centre for Health Education Scholarship, departments of Medicine, Surgery and Family Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Glenn Regehr
- Centre for Health Education Scholarship, departments of Medicine, Surgery and Family Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heather Frost
- Centre for Health Education Scholarship, departments of Medicine, Surgery and Family Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Joanna Bates
- Centre for Health Education Scholarship, departments of Medicine, Surgery and Family Medicine, University of British Columbia, Vancouver, BC, Canada
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Mohamed Osama O, Gallagher JE. Role models and professional development in dentistry: an important resource: The views of early career stage dentists at one academic health science centre in England. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2018; 22:e81-e87. [PMID: 28176433 DOI: 10.1111/eje.12261] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The importance of role models, and their differing influence in early, mid- and late careers, has been identified in the process of professional development of medical doctors. There is a paucity of evidence within dentistry on role models and their attributes. AIM To explore the views of early career dentists on positive and negative role models across key phases of professional development, together with role models' attributes and perceived influence. METHODS This is a phenomenological study collecting qualitative data through semi-structured interviews based on a topic guide. Dentists in junior (core training) hospital posts in one academic health science centre were all invited to participate. Interviews were recorded, transcribed verbatim and analysed using framework analysis. RESULTS Twelve early career stage dentists, 10 of whom were female, reported having role models, mainly positive, in their undergraduate and early career phases. Participants defined role models' attributes in relation to three distinct domains: clinical attributes, personal qualities and teaching skills. Positive role models were described as "prioritising the patient's best interests", "delivering learner-centred teaching and training" and "exhibiting a positive personality", whilst negative role models demonstrated the converse. Early career dentists reported having largely positive dentist role models during- and post-dental school and report their impact on professional values and aspirations, learning outcomes and career choice. CONCLUSION The findings suggest that these early career dentists in junior hospital posts have largely experienced and benefitted from positive role models, notably dentists, perceived as playing an important and creative influence promoting professionalism and shaping the career choices of early career stage dentists.
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Affiliation(s)
- O Mohamed Osama
- King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, Division of Population and Patient Health, London, UK
| | - J E Gallagher
- King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, Division of Population and Patient Health, London, UK
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Kemper KA, Rainey Dye C, Sherrill WW, Mayo RM. Guidelines for Public Health Practitioners Serving as Student Preceptors. Health Promot Pract 2016; 5:160-73. [PMID: 15090170 DOI: 10.1177/1524839903258164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Student fieldwork and service learning are valuable strategies for developing the skills of future public health professionals. Practitioners who serve as preceptors to students often receive little preparation for guiding and evaluating students. Findings from a review of fieldwork and service learning literature and a program evaluation of an undergraduate public health program at a large southern public university were used to construct guidelines for the practitioners supervising students in the field. These guidelines should aid practitioners in their role as preceptors of public health students. The guidelines address assessing student competencies, developing student competencies, writing learning objectives, evaluating students, maximizing the student precept or relationship, and managing problems.
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Affiliation(s)
- Karen A Kemper
- Department of Public Health Sciences at Clemson University in Clemson, South Carolina, USA
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Sternszus R, Macdonald ME, Steinert Y. Resident Role Modeling: "It Just Happens". ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:427-32. [PMID: 26579795 DOI: 10.1097/acm.0000000000000996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Role modeling by staff physicians is a significant component of the clinical teaching of students and residents. However, the importance of resident role modeling has only recently emerged, and residents' understanding of themselves as role models has yet to be explored. This study sought to understand residents' perceptions of themselves as role models, describe how residents learn about role modeling, and identify ways to improve resident role modeling. METHOD Fourteen semistructured interviews were conducted with residents in internal medicine, general surgery, and pediatrics at the McGill University Faculty of Medicine between April and September 2013. Interviews were audio-recorded and subsequently transcribed for analysis; iterative analysis followed principles of qualitative description. RESULTS Four primary themes were identified through data analysis: residents perceived role modeling as the demonstration of "good" behaviors in the clinical context; residents believed that learning from their role modeling "just happens" as long as learners are "watching"; residents did not equate role modeling with being a role model; and residents learned about role modeling from watching their positive and negative role models. CONCLUSIONS While residents were aware that students and junior colleagues learned from their modeling, they were often not aware of role modeling as it was occurring; they also believed that learning from role modeling "just happens" and did not always see themselves as role models. Helping residents view effective role modeling as a deliberate process rather than something that "just happens" may improve clinical teaching across the continuum of medical education.
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Affiliation(s)
- Robert Sternszus
- R. Sternszus is pediatrician, Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. M.E. Macdonald is assistant professor, Division of Oral Health and Society, Faculty of Dentistry, and core faculty member, Centre for Medical Education, McGill University, Montreal, Quebec, Canada. Y. Steinert is professor of family medicine and director, Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Smith JR, Lane IF. Making the Most of Five Minutes: The Clinical Teaching Moment. JOURNAL OF VETERINARY MEDICAL EDUCATION 2015; 42:271-80. [PMID: 26075624 DOI: 10.3138/jvme.0115-004r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Clinical educators face the challenge of simultaneously caring for patients and teaching learners, often with an unpredictable caseload and learners of varied abilities. They also often have little control over the organization of their time. Effective clinical teaching must encourage student participation, problem solving, integration of basic and clinical knowledge, and deliberate practice. Close supervision and timely feedback are also essential. Just as one develops an effective lecture through training and practice, clinical teaching effectiveness may also be improved by using specific skills to teach in small increments. The purpose of this paper is to identify potential teachable moments and to describe efficient instructional methods to use in the clinical setting under time constraints. These techniques include asking better questions, performing focused observations, thinking aloud, and modeling reflection. Different frameworks for teaching encounters during case presentations can be selected according to learner ability and available time. These methods include modeling and deconstructing the concrete experience; guiding the thinking and reflecting process; and providing the setting and opportunity for active practice. Use of these educational strategies encourages the learner to acquire knowledge, clinical reasoning, and technical skills, and also values, attitudes, and professional judgment.
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Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:718-25. [PMID: 25785682 DOI: 10.1097/acm.0000000000000700] [Citation(s) in RCA: 473] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Recent calls to focus on identity formation in medicine propose that educators establish as a goal of medical education the support and guidance of students and residents as they develop their professional identity. Those entering medical school arrive with a personal identity formed since birth. As they proceed through the educational continuum, they successively develop the identity of a medical student, a resident, and a physician. Each individual's journey from layperson to skilled professional is unique and is affected by "who they are" at the beginning and "who they wish to become."Identity formation is a dynamic process achieved through socialization; it results in individuals joining the medical community of practice. Multiple factors within and outside of the educational system affect the formation of an individual's professional identity. Each learner reacts to different factors in her or his own fashion, with the anticipated outcome being the emergence of a professional identity. However, the inherent logic in the related processes of professional identity formation and socialization may be obscured by their complexity and the large number of factors involved.Drawing on the identity formation and socialization literature, as well as experience gained in teaching professionalism, the authors developed schematic representations of these processes. They adapted them to the medical context to guide educators as they initiate educational interventions, which aim to explicitly support professional identity formation and the ultimate goal of medical education-to ensure that medical students and residents come to "think, act, and feel like a physician."
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Affiliation(s)
- Richard L Cruess
- R.L. Cruess is professor of surgery and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. S.R. Cruess is professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. J.D. Boudreau is associate professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. L. Snell is professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Y. Steinert is professor of family medicine and director, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Geller AC, Hayes RB, Leone F, Churchill LC, Leung K, Reed G, Jolicoeur D, Okuliar C, Adams M, Murray DM, Liu Q, Waugh J, David S, Ockene JK. Tobacco dependence treatment teaching by medical school clerkship preceptors: survey responses from more than 1,000 US medical students. Prev Med 2013; 57:81-6. [PMID: 23623894 PMCID: PMC3767283 DOI: 10.1016/j.ypmed.2013.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/10/2013] [Accepted: 04/15/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine factors associated with tobacco cessation counseling in medical school clerkships. METHODS Third-year medical students at 10 medical schools across the United States completed a 100-item survey, measuring the frequency with which they experienced their preceptors providing clinical teaching components: clear instruction, feedback, modeling behavior, setting clear objectives, and responding to questions about tobacco dependence counseling as well as frequency of use of tobacco prompts and office systems. Our primary dependent measure was student self-reported skill level for items of tobacco dependence treatment (e.g. "5As"). RESULTS Surveys were completed by 1213 students. For both family medicine and internal medicine clerkships, modeling and providing clear instruction on ways to provide tobacco counseling were reported most commonly. In contrast, providing feedback and clear objectives for tobacco dependence treatment lagged behind. Overall, students who reported preceptors' provision of optimal clinical teaching components and office system prompts in both family medicine and internal medicine clerkships had higher self-reported skill (P<0.001) than students with no exposure or exposure during only one of the clerkships. CONCLUSIONS Future educational interventions intended to help students adopt effective tobacco dependence treatment techniques should be engineered to facilitate these critical precepting components.
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Affiliation(s)
- Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA 02115, USA.
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Tam KL, Chandran K, Yu S, Nair S, Visvanathan R. Geriatric medicine course to senior undergraduate medical students improves attitude and self-perceived competency scores. Australas J Ageing 2013; 33:E6-11. [PMID: 24520979 DOI: 10.1111/ajag.12060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The aims were to evaluate the effect of a 4.5-week geriatric medicine course on 5th-year medical students' attitudes and self-perceived competency scores. Student performance in the summative multiple choice questions examination in 2011 was compared with results from 2008. METHODS Pre- and post-course attitudes (University of California, Los Angeles Attitudes Survey) and self-perceived competency surveys were administered to 65 5th-year medical students following a 4.5-week geriatric medicine course at one South Australian teaching hospital as part of course evaluation and improvement. RESULTS Significant improvements in students' attitude (mean pre- and post-attitude score (± standard deviation): 3.34 (1.66) vs 3.66 (1.06); P < 0.001) and self-perceived competency (mean pre and post-competency scores: 2.89 (0.84) and 4.03 (0.56); P < 0.001) were observed. The 2011 multiple choice question results were much better than in 2008 (91.5 (3.6) vs 75.2 (7.9); P < 0.001). CONCLUSIONS A geriatric medicine course for senior medical students allows for improvement in attitudes and self-perceived competency scores.
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Affiliation(s)
- Khai Loon Tam
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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Jahangiri L, McAndrew M, Muzaffar A, Mucciolo TW. Characteristics of effective clinical teachers identified by dental students: a qualitative study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2013; 17:10-8. [PMID: 23279387 DOI: 10.1111/eje.12012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/14/2012] [Indexed: 05/16/2023]
Abstract
This qualitative research study identified criteria for clinical teacher quality preferences as perceived by dental students. Third and fourth year dental students at New York University College of Dentistry were given a two question, open-ended survey asking what qualities they liked most and least in a clinical teacher. Responses were collected until data saturation was achieved. A total of 157 respondents provided a total of 995 written comments. Descriptive words within the responses were coded and grouped into key words, according to similar relationships, and further refined into 17 defined categories. Three core themes, Character, Competence and Communication, emerged from these 17 categories, which were validated according to specific references found in the existing educational literature. 'Character' comprised nine of the 17 defined categories: (caring, motivation, empathy, patience, professionalism, available, fairness, happiness, patient-centred) and yielded 59.1% of total student responses; 'Competence' consisted of five categories: knowledgeable, expertise, efficient, skilful, effective (29.2%); and 'Communication' represented the remaining three categories: feedback, approachable and interpersonal communication (11.7%). Positive and negative responses related to the defined category of caring were cited by 59.2% of all students. Motivation was the next highest category, cited by 45.9% of students. Non-cognitive attributes, especially those in the Character theme, comprised the majority of student comments. Because students' perceptions are so critical to understanding clinical teaching effectiveness in dental education, these findings can be used to develop assessments to measure clinical teaching effectiveness, to create criteria for the hiring and promotion of clinical faculty and to plan faculty development programming.
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Affiliation(s)
- L Jahangiri
- Department of Prosthodontics, New York University College of Dentistry, NY, USA
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Walters L, Greenhill J, Richards J, Ward H, Campbell N, Ash J, Schuwirth LWT. Outcomes of longitudinal integrated clinical placements for students, clinicians and society. MEDICAL EDUCATION 2012; 46:1028-41. [PMID: 23078680 DOI: 10.1111/j.1365-2923.2012.04331.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
CONTEXT Longitudinal integrated clerkships (LICs) have been widely implemented in both rural and urban contexts, as is now evident in the wealth of studies published internationally. This narrative literature review aims to summarise current evidence regarding the outcomes of LICs for student, clinician and community stakeholders. METHODS Recent literature was examined for original research articles pertaining to outcomes of LICs. RESULTS Students in LICs achieve academic results equivalent to and in some cases better than those of their counterparts who receive clinical education in block rotations. Students in LICs are reported to have well-developed patient-centred communication skills, demonstrate understanding of the psychosocial contributions to medicine, and report more preparedness in higher-order clinical and cognitive skills in comparison with students in traditional block rotations (TBRs). Students in LICs take on increased responsibility with patients and describe having more confidence in dealing with ethical dilemmas. Continuity of supervision reportedly facilitates incremental knowledge acquisition, and supervisors provide incrementally progressive feedback. Despite early disorientation regarding the organising of their learning, students feel well supported by the continuity of student-preceptor relationships and value the contributions made by these. Students in LICs living and working in rural areas are positively influenced towards primary care and rural career choices. DISCUSSION A sound body of knowledge in the field of LIC research suggests it is time to move beyond descriptive or exploratory research that is designed to justify this new educational approach by comparing academic results. As the attributes of LIC alumni are better understood, it is important to conduct explanatory research to develop a more complete understanding of these findings and a foundation for new theoretical frameworks that underpin educational change. CONCLUSIONS Longitudinal integrated clerkships are now recognised as representing credible and effective pedagogical alternatives to TBRs in medical education.
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Affiliation(s)
- Lucie Walters
- Flinders University Rural Clinical School, Faculty of Health Sciences, Flinders University, Mount Gambier, South Australia, Australia.
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Weitzel KW, Walters EA, Taylor J. Teaching clinical problem solving: A preceptor’s guide. Am J Health Syst Pharm 2012; 69:1588-99. [DOI: 10.2146/ajhp110521] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kristin W. Weitzel
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida (UF), Gainesville
| | | | - James Taylor
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, UF
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van der Zwet J, Zwietering PJ, Teunissen PW, van der Vleuten CPM, Scherpbier AJJA. Workplace learning from a socio-cultural perspective: creating developmental space during the general practice clerkship. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2011; 16:359-73. [PMID: 21188514 PMCID: PMC3139899 DOI: 10.1007/s10459-010-9268-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 12/13/2010] [Indexed: 05/08/2023]
Abstract
Workplace learning in undergraduate medical education has predominantly been studied from a cognitive perspective, despite its complex contextual characteristics, which influence medical students' learning experiences in such a way that explanation in terms of knowledge, skills, attitudes and single determinants of instructiveness is unlikely to suffice. There is also a paucity of research which, from a perspective other than the cognitive or descriptive one, investigates student learning in general practice settings, which are often characterised as powerful learning environments. In this study we took a socio-cultural perspective to clarify how students learn during a general practice clerkship and to construct a conceptual framework that captures this type of learning. Our analysis of group interviews with 44 fifth-year undergraduate medical students about their learning experiences in general practice showed that students needed developmental space to be able to learn and develop their professional identity. This space results from the intertwinement of workplace context, personal and professional interactions and emotions such as feeling respected and self-confident. These forces framed students' participation in patient consultations, conversations with supervisors about consultations and students' observation of supervisors, thereby determining the opportunities afforded to students to mind their learning. These findings resonate with other conceptual frameworks and learning theories. In order to refine our interpretation, we recommend that further research from a socio-cultural perspective should also explore other aspects of workplace learning in medical education.
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Affiliation(s)
- J van der Zwet
- Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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Kaye DK, Muhwezi WW, Kasozi AN, Kijjambu S, Mbalinda SN, Okullo I, Nabirye RC, Oria H, Atuyambe L, Groves S, Burnham G, Mwanika A. Lessons learnt from comprehensive evaluation of community-based education in Uganda: a proposal for an ideal model community-based education for health professional training institutions. BMC MEDICAL EDUCATION 2011; 11:7. [PMID: 21362181 PMCID: PMC3056836 DOI: 10.1186/1472-6920-11-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 03/01/2011] [Indexed: 05/30/2023]
Abstract
BACKGROUND Community-based education (CBE) can provide contextual learning that addresses manpower scarcity by enabling trainees acquire requisite experiences, competence, confidence and values. In Uganda, many health professional training institutions conduct some form of community-based education (CBE). However, there is scanty information on the nature of the training: whether a curriculum exists (objectives, intended outcomes, content, implementation strategy), administration and constraints faced. The objective was to make a comprehensive assessment of CBE as implemented by Ugandan health professional training institutions to document the nature of CBE conducted and propose an ideal model with minimum requirements for health professional training institutions in Uganda. METHODS We employed several methods: documentary review of curricula of 22 institutions, so as to assess the nature, purpose, outcomes, and methods of instruction and assessment; site visits to these institutions and their CBE sites, to assess the learning environment (infrastructure and resources); in-depth interviews with key people involved in running CBE at the institutions and community, to evaluate CBE implementation, challenges experienced and perceived solutions. RESULTS CBE was perceived differently ranging from a subject, a course, a program or a project. Despite having similar curricula, institutions differ in the administration, implementation and assessment of CBE. Objectives of CBE, the curricula content and implementation strategies differ in similar institutions. On collaborative and social learning, most trainees do not reside in the community, though they work on group projects and write group reports. Lectures and skills demonstrations were the main instruction methods. Assessment involved mainly continuous assessment, oral or written reports and summative examination. CONCLUSION This assessment identified deficiencies in the design and implementation of CBE at several health professional training institutions, with major flaws identified in curriculum content, supervision of trainees, inappropriate assessment, trainee welfare, and underutilization of opportunities for contextual and collaborative learning. Since CBE showed potential to benefit the trainees, community and institutions, we propose a model that delivers a minimum package of CBE and overcomes the wide variation in the concept, conduct and implementation of CBE.
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Affiliation(s)
- Dan K Kaye
- Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Wilson W Muhwezi
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Ann N Kasozi
- Office of the Dean, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Steven Kijjambu
- Office of the Dean, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Scovia N Mbalinda
- Department of Nursing, School of Health Sciences, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Isaac Okullo
- Department of Dentistry, School of Health Sciences, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Rose C Nabirye
- Department of Nursing, School of Health Sciences, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Hussein Oria
- Department of Pharmacy, School of Health Sciences, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Lynn Atuyambe
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Sarah Groves
- Department of Nursing, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Gilbert Burnham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Mwanika
- Department of Dentistry, School of Health Sciences, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Lichtman R, Burst HV, Campau N, Carrington B, Diegmann EK, Hsia L, Thompson JE. Pearls of Wisdom for Clinical Teaching: Expert Educators Reflect. J Midwifery Womens Health 2010. [DOI: 10.1016/s1526-9523(03)00346-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Graeme Dewhurst
- Department of Medicine, St Richard's Hospital, Chichester, West Sussex.
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Park J, Woodrow SI, Reznick RK, Beales J, MacRae HM. Observation, reflection, and reinforcement: surgery faculty members' and residents' perceptions of how they learned professionalism. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:134-9. [PMID: 20042839 DOI: 10.1097/acm.0b013e3181c47b25] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE To explore perceptions of how professionalism is learned in the current academic environment. Professionalism is a core competency in surgery (as in all of medical practice), and its presence or absence affects all aspects of clinical education and practice, but the ways in which professional values and attitudes are best transmitted to developing generations of surgeons have not been well defined. METHOD The authors conducted 34 semistructured interviews of individual surgery residents and faculty members at two academic institutions from 2004 to 2006. Interviews consisted of open-ended questions on how the participants learned professionalism and what they perceived as challenges to learning professionalism. Two researchers analyzed the interview transcripts for emergent themes by using a grounded-theory approach. RESULTS Faculty members' and residents' perceptions of how they learned professionalism reflected four major themes: (1) personal values and upbringing, including premedical education experiences, (2) learning by example from professional role models, (3) the structure of the surgery residency, and (4) formal instruction on professionalism. Of these, role modeling was the dominant theme: Participants identified observation, reflection, and reinforcement as playing key roles in their learning from role models and in distinguishing the sometimes blurred boundary between positive and negative role models. CONCLUSIONS The theoretical framework generated out of this study proposes a focus on specific activities to improve professional education, including an active approach to role modeling through the intentional and explicit demonstration of professional behavior during the course of everyday work; structured, reflective self-examination; and timely and meaningful evaluation and feedback for reinforcement.
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Affiliation(s)
- Jason Park
- Department of Surgery and the Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.
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Rademacher R, Simpson D, Marcdante K. Critical incidents as a technique for teaching professionalism. MEDICAL TEACHER 2010; 32:244-249. [PMID: 20218840 DOI: 10.3109/01421590903197001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The issue of professional behavior in medicine has been extensively discussed in the medical literature and clarity regarding what constitutes professional behavior, and strategies for assessing professionalism have begun to emerge. AIM To address the information gap on effective strategies for teaching professionalism. METHODS The critical incident technique (CIT) established by Flanagan has proven to be a useful way to structure teaching and/or evaluation of professionalism. RESULTS By analyzing 'real-life' occurrences of unprofessional behavior with learners, the CIT yields common terminology and definitions of professionalism that can be explored within a structured framework for discussion. CONCLUSIONS CIT is a versatile strategy as it can be utilized with varied audiences (e.g., students, faculty), in a wide array of settings (e.g., workshops, grand rounds). Examples of CIT use associated with teaching professionalism are reviewed and key features associated with its success are identified.
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Affiliation(s)
- Ruth Rademacher
- Division of Neonatology, Medical College of Wisconsin, Milwaukee, WI 53201-1997, USA.
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van Mook WNKA, van Luijk SJ, de Grave W, O'Sullivan H, Wass V, Schuwirth LW, van der Vleuten CPM. Teaching and learning professional behavior in practice. Eur J Intern Med 2009; 20:e105-11. [PMID: 19712827 DOI: 10.1016/j.ejim.2009.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 12/18/2008] [Accepted: 01/04/2009] [Indexed: 11/29/2022]
Abstract
This paper is the fourth article in a series on Professionalism and provides an overview of current methods used for teaching and learning about professionalism. The questions "whether" and "how" professionalism can be placed in the formal medical school curricula are addressed, and the informal learning related to professionalism reviewed.
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Affiliation(s)
- Walther N K A van Mook
- Department of Intensive Care and Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
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van Mook WNKA, van Luijk SJ, O'Sullivan H, Wass V, Schuwirth LW, van der Vleuten CPM. General considerations regarding assessment of professional behaviour. Eur J Intern Med 2009; 20:e90-5. [PMID: 19524166 DOI: 10.1016/j.ejim.2008.11.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 11/16/2008] [Indexed: 10/21/2022]
Abstract
Core medical knowledge has been assessed for over fifty years and technical and communication skills for at least twenty. The assessment of professionalism however has failed to achieve recognition within this time frame. The interest in the assessment of professionalism and professional behaviour thus is a fairly recent development. This article will firstly clarify how professional behaviour assessment relates to other assessment methods using the framework proposed by Miller6. Thereafter a brief overview will be provided of the current "tool box" of methods available to assess professionalism. Data on the validity, reliability, feasibility, acceptability and educational utility of these "tools" as derived from published evidence will be reviewed. Subsequently a general overview of the way forward in the assessment of professionalism and professional behaviour will be given.
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Affiliation(s)
- Walther N K A van Mook
- Department of Intensive Care and Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Affiliation(s)
- Juanita S. Wallace
- Department of Dental Hygiene; University of Texas Health Science Center; San Antonio
| | - Taline D. Infante
- Department of Dental Hygiene; University of Texas Health Science Center; San Antonio
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Cole B, Wessel J. How clinical instructors can enhance the learning experience of physical therapy students in an introductory clinical placement. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2008; 13:163-79. [PMID: 17120080 DOI: 10.1007/s10459-006-9030-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 08/23/2006] [Indexed: 05/12/2023]
Abstract
PURPOSE There is little understanding of how physical therapy students are influenced by clinical instructors (CIs) particularly at the outset of their clinical learning. The purpose of this study was to evaluate physical therapy students' perceptions of their learning experiences during an introductory clinical placement. METHODS Subjects were 51 physical therapy students participating in an introductory clinical placement following the first unit (semester) of a 2-year, entry-level Master's program. Each day of their placement, students completed a questionnaire based on Brookfield's Critical Incident Questionnaire. Students were asked when they felt most engaged or distanced, what actions of others were most affirming or puzzling, and what surprised them about the placement that day. Two evaluators independently read and coded the entries in all questionnaires, and then collaborated to establish themes related to the behaviors of the CI. RESULTS The CI could enrich the students' experiences in the following ways: (1) prepare them by introducing, explaining, demonstrating, or allowing them time to obtain information. (2) Confirm learning by providing feedback and recapping. (3) Provide "hands on" experiences appropriate to students' knowledge, skills and comfort. (4) Challenge students by questioning, discussing possibilities, or providing time for reflection. (5) Respect students, value their input and allow them an appropriate level of independence. (6) Demonstrate professional behavior related to communication, evidence-based practice and continuing education. CONCLUSIONS Physical therapy students value CIs who involve them in patient care; confirm, challenge and prepare them for learning; respect their input and model professional behavior.
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Affiliation(s)
- Beverley Cole
- School of Rehabilitation Science, McMaster University, 1400 Main St, West, Hamilton, ON, Canada
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Abstract
Teachers need to be aware of the conscious and unconscious components of learning from role modelling, so that the net effect of the process is positive
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Affiliation(s)
- Sylvia R Cruess
- Centre for Medical Education, McGill University, 1110 Pine Avenue West, Montreal, QC, Canada H3A 1A3.
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Lie D, Boker J, Gutierrez D, Prislin M. What do medical students learn from early clinical experiences (ECE)? MEDICAL TEACHER 2006; 28:479-82. [PMID: 16973466 DOI: 10.1080/01421590600628530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
What are the common learning themes perceived by medical students during ECE with varying practice settings and patient profiles? Retrospective qualitative and quantitative analyses of structured descriptive reports completed by one class (n = 92) for 895 observed patient encounters identified common learning themes. Identified themes were examined by practice setting and patient characteristics. Student response rates were 85 to 94% across settings. Fifty-five percent of ECE were in outpatient settings. Chief complaints were predominantly medical (67%); only 20% represented psychosocial and 8% preventive care, respectively (5% were ambiguous). The five most common learning themes (out of 13 themes coded) were communication (>50%), procedures/time management, cross-cultural issues, feeling useful as a student, and presenting medical problems. Cross-cultural issues were addressed mainly in community settings. Negative learning occurred only rarely (<3%). Student observations from ECE can be used by course managers to design effective early clinical exposures to address specific course learning objectives.
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Affiliation(s)
- Désirée Lie
- University of California Irvine School of Medicine, California, USA.
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Henzi D, Davis E, Jasinevicius R, Hendricson W. North American Dental Students’ Perspectives About Their Clinical Education. J Dent Educ 2006. [DOI: 10.1002/j.0022-0337.2006.70.4.tb04091.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- David Henzi
- Division of Educational Research and Development; Department of Academic Informatics Services; University of Texas Health Science Center; San Antonio
| | - Elaine Davis
- State University of New York; School of Dental Medicine; Buffalo
| | - Roma Jasinevicius
- Department for the Practice of General Dentistry; Case Western Reserve University; School of Dental Medicine
| | - William Hendricson
- Division of Educational Research and Development; Department of Academic Informatics Services; University of Texas Health Science Center; San Antonio
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Simon SR, Davis D, Peters AS, Skeff KM, Fletcher RH. How do precepting physicians select patients for teaching medical students in the ambulatory primary care setting? J Gen Intern Med 2003; 18:730-5. [PMID: 12950482 PMCID: PMC1494919 DOI: 10.1046/j.1525-1497.2003.20838.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study how clinical preceptors select patients for medical student teaching in ambulatory care and to explore key factors they consider in the selection process. DESIGN Qualitative analysis of transcribed interviews. SETTING Harvard Medical School, Boston, Mass. PARTICIPANTS Nineteen physicians (14 general internists and 5 general pediatricians) who serve as clinical preceptors. MEASUREMENTS Responses to in-depth open-ended interview regarding selection of patients for participation in medical student teaching. MAIN RESULTS Preceptors consider the competing needs of the patient, the student, and the practice the most important factors in selecting patients for medical student teaching. Three dominant themes emerged: time and efficiency, educational value, and the influence of teaching on the doctor-patient relationship. These physicians consciously attempt to select patients whose participation in medical student teaching maximizes the efficiency of the clinical practice and optimizes the students' educational experiences, while minimizing any potential for harming the relationship between preceptor and patient. CONCLUSIONS These findings may help validate the frustration preceptors frequently feel in their efforts to teach in the outpatient setting. Becoming more cognizant of the competing interests-the needs of the patient, the student, and the practice-may help physicians to select patients to enhance the educational experience without compromising efficiency or the doctor-patient relationship. For educators, this study suggests an opportunity for faculty development programs to assist the clinical preceptor both in selecting patients for medical student teaching and in finding ways to maximize the efficiency and educational quality of the outpatient teaching environment.
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Affiliation(s)
- Steven R Simon
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA.
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Ferenchick GS, Chamberlain J, Alguire P. Community-based teaching: defining the added value for students and preceptors. Am J Med 2002; 112:512-7. [PMID: 11959077 DOI: 10.1016/s0002-9343(02)01093-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gary S Ferenchick
- Department of Internal Medicine, Michigan State University College of Human Medicine, USA
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Howe A. Patient-centred medicine through student-centred teaching: a student perspective on the key impacts of community- based learning in undergraduate medical education. MEDICAL EDUCATION 2001; 35:666-72. [PMID: 11437969 DOI: 10.1046/j.1365-2923.2001.00925.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
CONTEXT The UK General Medical Council has proposed that increased use of community settings is essential to enhancement of medical education. However, such curriculum developments have been directed by educationalists and clinical faculty; there is to date little to show whether student perspectives accord with such expectations. AIM To examine student views on whether community-based learning during a UK undergraduate medical education course results in new learning in the areas expected, and to elucidate any process factors which enhance attainment of learning objectives. METHOD Nominal group technique, to develop consensus on important learning outcomes and process factors, and questionnaire survey, developed from the views of the nominal groups. RESULTS 89 students participated (response rate 70% for the nominal groups, and 88% for questionnaire). Students perceived increased learning in many of the areas expected. In particular, students reported significant learning from: witnessing the impact of a longer term and more personal relationship with patients; the visible impact of social environment on health; the importance of dealing with people rather than diseases, and the use of the whole team for care. In addition, they emphasized that tutor, staff and patient enthusiasm for student presence and learning greatly enhanced the student learning experience. CONCLUSIONS Community settings appear to achieve the expected attitudinal adaptation of students. The role of the committed tutor and team is seen as pivotal to learning. The conclusions support an increased emphasis in contemporary medical education and related research activity on the key impact of relationships in the learning environment.
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Affiliation(s)
- A Howe
- Institute of General Practice and Primary Care, Community Sciences Centre, Northern General Hospital, Sheffield, UK
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Loayssa Lara J, González García F. [Cognitive structure of family doctors in training concerning the doctor-patient relationship]. Aten Primaria 2001; 28:158-66. [PMID: 11459521 DOI: 10.1016/s0212-6567(01)78925-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To find and compare thought structures of family doctors in training concerning the doctor-patient relationship. DESIGN Qualitative and descriptive. SETTING Primary care. PARTICIPANTS 10 first-year residents selected through intentional sampling. MEASUREMENTS Piaget interview modified by Pinies evaluated with the propositional analysis technique of concepts and conceptual maps. Five thematic areas concerning doctor-patient relationship were defined: importance and repercussions, characteristics and requisites, model of relationship, patient behaviour and doctor's behaviour. RESULTS The concepts were not sufficiently elaborated. The importance of the doctor-patient relationship was recognised, but not all its repercussions. Its most oft cited desirable requisite was patient confidence. Those interviewed opted for a relationship in which the patient is passive, although they were aware of the danger of leading questions. The personality of the patient was the most commonly cited determinant of his/her behaviour, but other determinants were mentioned, such as beliefs and expectations. The decision to go for a consultation was not seen just as a product of the symptoms. Denial was the most widely recognised defence mechanism. The role of the doctor's feelings was indicated, but not about how to neutralise them. Training was not emphasised, either. CONCLUSIONS There was insufficient appreciation of the practical importance of the doctor-patient relationship. A directive model of relationship was most common, lacking any biopsychosocial orientation. Training in this area, even though its need is not perceived, should be prioritised. The kind of knowledge underlying doctors' cognitive structure and its role in their behaviour should be investigated.
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Affiliation(s)
- J Loayssa Lara
- Centro de Salud de Noain. Servicio Navarro de Salud-Osasunbidea y Departamento de Psicología y Pedagogía. Universidad Pública de Navarra.
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Affiliation(s)
- A A Kuo
- Department of Paediatrics, UCLA Medical Center, Los Angeles, CA 90095, USA
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Abstract
Doctors must increasingly be aware of what they should be, as well as what they should know. Professionalism, including a value system that supports the compassionate care of patients, is a means of encapsulating and prioritising these competing responsibilities. Accordingly, in this article, we assume that professionalism is an essential aspect of medical practice that needs to be taught to those entering medicine. We first describe critiques of professionalism and current challenges to it, in practice and in medical education. We then assess the current efforts of curriculum reform to incorporate professionalism and the methods used to teach it. Adopting and assessing such approaches to ensure that they are effective is of central importance in the education of future clinicians.
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Affiliation(s)
- A Stephenson
- Department of General Practice and Primary Care, GKT School of Medicine, King's College, London, UK.
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Walling AD, Sutton LD, Gold J. Administrative relationships between medical schools and community preceptors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2001; 76:184-187. [PMID: 11158843 DOI: 10.1097/00001888-200102000-00021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To determine the current administrative relationships between medical schools and community preceptors, with special emphasis on arrangements for academic appointment, review, and promotion. METHOD In 1999, administrative contacts at all 126 U.S. allopathic medical schools were mailed a ten-item questionnaire to elicit information concerning the current practices of the schools regarding community preceptors, who were defined as volunteer or part-time physician faculty, primarily practicing at non-university-owned facilities, who contribute to medical students' and/or residents' education in various specified ways. RESULTS Responses were received from 71 (56%) of the schools; they were in general a representative sample of U.S. medical schools. The numbers of preceptors per school ranged from 40 to 3,500. Sixty-seven percent of reporting schools identified clinical departments as the main administrative interface with preceptors. Only three schools used a central office; none exclusively used a regionalized system. Forty-four schools (63.8%) reported using formal written criteria for all preceptor appointments. Sixty-six schools (93%) used consistent academic titling systems, with 83.3% using titles including the word "clinical." Thirty-three schools (47.8%) reported that their departments conducted regular preceptor reviews; an additional 28 reported reviews by some departments. Preceptors were eligible for promotion at 94.4% of the responding schools. At 46.8%, specific promotion criteria exist; four schools were developing such criteria. Preceptors' interest in academic promotion was perceived to be moderate or low. CONCLUSION A substantial proportion of U.S. medical schools have taken action to recognize preceptors as a unique faculty group. The comments received indicate that this is an active area of development in faculty affairs policy.
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Affiliation(s)
- A D Walling
- University if Kansas School of Medicine, Kansas City, USA.
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Fernald DH, Staudenmaier AC, Tressler CJ, Main DS, O'Brien-Gonzales A, Barley GE. Student perspectives on primary care preceptorships: enhancing the medical student preceptorship learning environment. TEACHING AND LEARNING IN MEDICINE 2001; 13:13-20. [PMID: 11273374 DOI: 10.1207/s15328015tlm1301_4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Medical students participate in a longitudinal (3-year) primary care preceptorship to assist them in developing skills in interviewing and examining patients in an ambulatory care setting. PURPOSE To identify from a student's perspective important context and process issues in a longitudinal preceptorship. METHODS The investigators used an "editing" style of analysis to identify significant themes across 24 medical student focus groups held between October 1995 and December 1997. RESULTS Significant themes emerged from the data analysis that describe important features of what makes the preceptorship work for students. The main themes are active teaching, active learning, a trusting relationship, sufficient time, and a shared understanding of preceptorship objectives. The potential benefits to students in an enhanced learning environment are comfort, confidence, responsibility, skills, knowledge, reinforcement, learning opportunities, teaching opportunities, and models for practice. CONCLUSIONS We offer recommendations for enhancing longitudinal preceptorships for preceptors, students, and leaders in medical education.
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Affiliation(s)
- D H Fernald
- Department of Family Medicine, University of Colorado Health Sciences Center, 1180 Clermont Street, Denver, Colorado, 80220 USA.
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